| Backgrounds and objectives:Epilepsy is a common neurological disease.There are about 6 million active epilepsy patients in China,and there are about400 thousand people are newly diagnosed with epilepsy each year.This brings a lot of economic burden to the sick families,and it also brings a great burden to the medical cause of our country.Sodium valproate(VPA)and oxcarbazepine (OXC)are widely used as first-line drugs for generalized tonic–clonic seizures and partial secondary generalized tonic–clonic seizures in clinical.However,there are few studies on the effects of the two drugs on the semen,sexual function and sex hormone in young men with epilepsy.The aim of this study is to investigate the effects of VPA and OXC on semen quality,sexual function and sex hormone levels in newly diagnosed young male epilepsy patients,so as to provide reference for patients to select antiepileptic drugs(AEDs).Materials and methods:1.We consecutively enrolled the newly diagnosed young male(18-44 years old)epileptic patients(generalized tonic–clonic seizures and partial secondary generalized tonic–clonic seizures)in the epilepsy center of Sichuan Academy&Sichuan Provincial People's Hospital from April 2015 to November 2016 as the object of research.In addition,healthy young men at the same time were recruited as the control group.The semen quality and serum sex hormone levels of all patients and volunteers were measured.Meanwhile,the International Index of Erectile Function-5(IIEF-5)and the Premature Ejaculation Diagnostic Tool(PEDT)were used to evaluate the sexual function of all epilepsy patients and volunteers with sexual life.The semen quality,sexual function questionnaire scores and sex hormone levels were compared between the two groups.2.The epileptic patients were treated with VPA or OXC.After 6 months and 12months of medication,the semen quality and sex hormone levels of the two groups were detected again,and the IIEF-5 and PEDT were used to evaluate the sexual function of the patients with sexual life.Finally,The semen quality,sexual function questionnaire scores and sex hormone levels were compared between before medication,6 months of medication and 12 months of medication in VPA group and OXC group.Results:1.In this study,44 cases of young male epileptic patients were included(epilepsy group),their age was 26.8±6.3 years(range:18-44years),and the body mass index(BMI)was 23.4±2.0kg/m~2(range:17.6-28.3kg/m~2),among them 19 people have married(43%),7 people married with children(16%),38 people with sexual life(86%).In addition,30 cases of young male healthy volunteers were included in this study(control group),their age was 27.9±4.6 years(range:22-44 years),the BMI was24.0±2.2kg/m~2(range:17.9-27.9kg/m~2),among them 26 people have married(87%),21 people married with children(70%),28 people with sexual life(93%).There was no significant difference in the age,BMI and sexual life experience between the epilepsy group and the control group.The rate of marriage and fertility in the epilepsy group was significantly lower than that in the control group(P<0.01).2.Finally,23 young male epileptic patients were treated with VPA(VPA group),their age was 27.4±6.5 years(range:20-44years),the BMI was 23.4±2.2kg/m~2(range:17.9-27.9kg/m~2),the course of disease was 4.3±2.7 years(range:1-12years),among them 10 people have married(43%),3 people have children(13%),20 people with sexual life(87%),18 patients with partial secondary generalized tonic–clonic seizures(78%),5 patients with generalized tonic–clonic seizures(22%),and the dosage of VPA was 1190±295mg/d(range:1000-2000mg/d).21 young male epileptic patients were treated with OXC(OXC group),their age was 26.2±6.2 years(range:18-40 years),the BMI was 23.5±1.9kg/m~2(range:18.9-25.9kg/m~2),the course of disease was 4.7±3.3 years(range:1-14years),among them 9 people have married(43%),4 people have children(19%),18 people with sexual life(86%),16 patients with partial secondary generalized tonic–clonic seizures(76%),5 patients with generalized tonic–clonic seizures(24%),and the dosage of OXC was 706±182mg/d(range:600-1200mg/d).There was no statistical difference between the VPA group and the OXC group in terms of age,BMI,course of disease,rate of marriage and fertility,sexual life experience,and seizure type.3.When the semen quality,sexual function questionnaire scores,and sex hormone levels of epilepsy group compared with those of control group,the concentration of sperm and the total number of sperm in the epilepsy group were significantly reduced(P<0.01),the percentage of sperm in the forward movement and the percentage of normal morphology sperm had a decreasing trend but there was no statistical difference(P>0.05);the IIEF-5scores in the epilepsy group significantly decreased(P<0.01),the PEDT scores had a increasing trend but there was no statistical difference(P>0.05);the prolactin(PRL)levels in the epilepsy group showed a upward trend,the follicle stimulating hormone(FSH)levels and luteinizing hormone(LH)levels showed a downward trend but without statistical differences(P>0.05).4.When the semen quality,sexual function questionnaire scores and sex hormone levels of patients in VPA group after 6 months of medication compared with those before medication,the sperm concentration,sperm count and the percentage of forward motile sperm decreased significantly(P<0.01),the percentage of normal morphology sperm also showed a downward tend but without statistical differences(P>0.05);the IIEF-5 scores showed a downward trend but without statistical differences(P>0.05)and the PEDT scores increased(P<0.05);the PRL levels increased(P<0.05),the FSH levels and LH levels showed a downward tend but without statistical differences(P>0.05).When the semen quality,sexual function questionnaire scores and sex hormone levels after 12 months of medication compared with those before medication,the sperm concentration,sperm count and the percentage of forward motile sperm decreased significantly(P<0.01),the percentage of normal morphology sperm also showed a downward tend but without statistical differences(P>0.05);the IIEF-5 scores decreased and the PEDT scores increased significantly(P<0.01),the PRL levels increased(P<0.05),the FSH levels and LH levels showed a downward tend but without statistical differences(P>0.05).When the semen quality,sexual function questionnaire scores and sex hormone levels after 12 months of medication compared with those after 6 months of medication,there were no significant changes in sperm concentration,sperm count,the percentage of forward motile sperm and the percentage of normal morphology sperm(P>0.05);the IIEF-5 scores showed a downward tend and the PEDT scores showed a upward tend but without statistical differences(P>0.05);the FSH levels showed a downward tend but without statistical differences(P>0.05).5.When the semen quality,sexual function questionnaire scores and sex hormone levels of patients in OXC group after 6months of medication compared with those before medication,the sperm concentration,sperm count,the percentage of forward motile sperm and the percentage of normal morphology sperm showed a upward tend but without statistical differences(P>0.05);the IIEF-5 scores showed a upward tend and the PEDT scores showed a downward tend but without statistical differences(P<0.05);the FSH levels increased significantly(P<0.01),the PRL levels showed a downward tend and the LH levels,testosterone(T)levels showed a upward tend but without statistical differences(P>0.05).When the semen quality,sexual function questionnaire scores and sex hormone levels after 12months of medication compared with those before medication,the sperm concentration,sperm count,the percentage of forward motile sperm and the percentage of normal morphology sperm showed a upward tend but without statistical differences(P>0.05);the IIEF-5 scors increased and the PEDT scores decreased significantly(P<0.01);the FSH levels increased significantly(P<0.01),the PRL levels showed a downward tend while the LH levels,T levels showed a upward tend but without statistical differences(P>0.05).When the semen quality,sexual function questionnaire scores and sex hormone levels after 12 months of medication compared with those after 6months of medication,there were no significant changes in sperm concentration,sperm count,the percentage of forward motile sperm and the percentage of normal morphology sperm(P>0.05);the score of IIEF-5 showed a upward tend and the score of PEDT showed a downward tend but without statistical differences(P<0.05);there were no significant changes in FSH levels,PRL levels,LH levels,T levels and estradiol(E2)levels(P>0.05).Conclusion:1.The semen quality and sexual function of young male epileptic patients were lower than those of healthy young men.2.VPA may decrease the semen quality,sexual function and increase the level of PRL in young men with epilepsy.3.OXC may be beneficial in improving semen quality in young men with epilepsy,and it can improve patient's sexual function,increase the level of FSH.4.Compared with VPA,OXC may be more suitable for young male epileptic patients with reproductive requirements. |
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